Ng W K, Tang V
Department of Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
Diagn Cytopathol. 2001 Dec;25(6):406-10. doi: 10.1002/dc.10024.
We report on the crush preparation findings of a case of "sarcomatoid" chordoma occurring in the sacral region of a 78-yr-old Chinese male. The smears showed clumps and small cords of polygonal tumor cells containing bubbly cytoplasm and round to oval nuclei. Focally, there were also aggregates of long filamentous spindle cells and stellate bizarre cells with marked nuclear pleomorphism. Occasional tumor cells were seen in association with dense amorphous material. Histologic examination of the excised specimen showed features of the so-called "sarcomatoid" chordoma which consisted of prominent foci of mitotically inactive spindle and pleomorphic cells, in addition to the conventional chordoma areas. An osteosarcoma-like pattern of probably metaplastic nature was also seen within the tumor. Immunohistochemical study showed that most tumor cells expressed cytokeratins. Ultrastructural examination revealed the characteristic rough endoplasmic reticulum-mitochondria complexes. While there are many spindle and pleomorphic cells seen in crush preparations, the distinction from other true high-grade malignancies is important. Recognition of these "pseudoanaplastic" cytologic features also helps to expand the morphologic spectrum of chordoma.
我们报告了一例发生在一名78岁中国男性骶骨区域的“肉瘤样”脊索瘤的压片制备结果。涂片显示多角形肿瘤细胞的团块和小条索，胞质呈泡沫状，核圆形至椭圆形。局部还可见长丝状梭形细胞和具有明显核多形性的星状怪异细胞聚集。偶尔可见肿瘤细胞与致密无定形物质相关。切除标本的组织学检查显示所谓“肉瘤样”脊索瘤的特征，除了传统的脊索瘤区域外，还包括有丝分裂不活跃的梭形和多形性细胞的显著灶。肿瘤内还可见可能具有化生性质的骨肉瘤样模式。免疫组织化学研究显示大多数肿瘤细胞表达细胞角蛋白。超微结构检查揭示了特征性的粗面内质网-线粒体复合物。虽然在压片制备中可见许多梭形和多形性细胞，但与其他真正的高级别恶性肿瘤相鉴别很重要。认识这些“假间变”细胞学特征也有助于扩展脊索瘤的形态学谱。
